THE number of elective and emergency caesarean deliveries across Wye Valley NHS Trust is recognised as too high.

Caesarean practice at Hereford County Hospital featured in evidence put to an inquest into the death of two-day-old Harley Keddie this week.

The inquest heard how the death followed a delayed ”code red”  emergency caesarean delivery.

Caesarean rates across the trust are recognised as too high. Numbers put to this month’s meeting of the trust board were said to be well over internal targets.

Over September this year the trust’s elective c-section  rate was 12.2 per cent in September and 13.3 per cent in October against the 9.7 per cent  national average for each month.

Emergency c-section rates were 17.1 per cent in September and 18.9 per cent in October against a 15.4 per cent national average for each month.

The board heard that the increase was “almost entirely attributable” to a rise in the numbers of women delivering in two specific category groups.

A classification system called Robson Ten provides a means of comparing  c-section rates by groups.

The trust attributes the rise to Robson Group 1 (spontaneously labouring first time mothers) and Robson Group 2 (women in their first pregnancy who are induced or have a c-section before labour).

Average monthly figures over July-September were three c-sections  a month in Groups 1 & 2.

In October there were eight c-sections in Group 1  and nine in Group 2 which went against a reducing trend seen over six months.

Already, the trust’s head of quality & safety has discussed the rise with the consultant  lead for risk within the Integrated Family Health Service Unit.

Currently each emergency c-section is discussed at the labour ward and potentially avoidable  sections flagged to those involved.

Additional work is also currently been undertaken in relation to ascertaining comparable data between consultants and the feeding back of results.

The board was told that the “overall focus”  remains on reduction of both elective and emergency c-sections with work underway to implement “enhanced education” for midwives and obstetricians in relation to normalised birth.

C-sections are also subject to on-going audit for quarterly reports to the trust’s quality committee.

The board heard that if future monitoring did not reveal a reduction in rates, additional reviews will be undertaken taking in factors as definitive as time of day and consultant presence.

A coroner at the Keddie inquest recorded a narrative verdict on the baby’s death.

Evidence put to the inquest outlined hospital staff realising the baby’s life was in danger with the mother in labour.

A “code red” was called for an emergency c-section, but, as there was no operating theatre available a ventouse delivery was attempted before the baby was delivered by c-section some 34 minutes since the initial decision for a c section and four minutes longer than the recommended time.

Harley was transferred to New Cross Hospital, Wolverhampton, where he died on March 22.

Coroner Roland Wooderson  recorded the cause of death as massive hypoxic–ischaemic brain damage saying that the attempted ventouse delivery caused a large bleed to the brain.

 Post mortem findings were, the inquest heard, consistent with multi organ failure linked to the complications of birth including the haemorrhage.

Speaking after the inquest, Harley’s mother Hayley Jones called maternity staff  “extremely chaotic”.

“I believe if they had acted differently and I was referred quickly up to theatre for a c section then Harley would be still with us.

For Harley’s death to not be in vain improvements must be made to prevent any other family from being put through the same hell and losing their precious baby.”

In response, the trust said it has since made a number of changes including arrangements for the anaesthetic room on delivery suite to be converted into an emergency theatre if required and clear lines of communication and responsibility agreed and practiced.

Dr Sally Stucke, medical director at the trust, said: “We have carried out an in-depth investigation into the death of baby Harley and have made changes which will allow us to respond differently should the same emergency situation arise again in the future.”